SummaryBackground Nonmelanoma skin cancer (NMSC) is the most common cancer affecting white-skinned individuals and the incidence is increasing worldwide. Objectives This systematic review brings together 75 studies conducted over the past half century to look at geographical variations and trends worldwide in NMSC, and specifically incidence data are compared with recent U.K. cancer registry data. Methods Following the development of a comprehensive search strategy, an assessment tool was adapted to look at the methodological quality of the eligible studies.Results Most of the studies focused on white populations in Europe, the U.S.A. and Australia; however, limited data were available for other skin types in regions such as Africa. Worldwide the incidence for NMSC varies widely with the highest rates in Australia [> 1000 ⁄100 000 person-years for basal cell carcinoma (BCC)] and the lowest rates in parts of Africa (< 1 ⁄100 000 person-years for BCC). The average incidence rates in England were 76AE21 ⁄100 000 personyears and 22AE65 ⁄100 000 person-years for BCC and squamous cell carcinoma (SCC), respectively, with highest rates in the South-West of England (121AE29 ⁄100 000 person-years for BCC and 33AE02 ⁄100 000 person-years for SCC) and lowest rates by far in London (0AE24 ⁄100 000 person-years for BCC and 14AE98 ⁄100 000 person-years for SCC). The incidence rates in the U.K. appear to be increasing at a greater rate when compared with the rest of Europe. Conclusions NMSC is an increasing problem for health care services worldwide. This review highlights a requirement for prevention studies in this area and the issues surrounding incomplete NMSC registration. Registration standards of NMSC should be improved to the level of other invasive disease.

BackgroundThere is uncertainty about the influence of diet during pregnancy and infancy on a child’s immune development. We assessed whether variations in maternal or infant diet can influence risk of allergic or autoimmune disease.Methods and findingsTwo authors selected studies, extracted data, and assessed risk of bias. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess certainty of findings. We searched Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), and Literatura Latino Americana em Ciências da Saúde (LILACS) between January 1946 and July 2013 for observational studies and until December 2017 for intervention studies that evaluated the relationship between diet during pregnancy, lactation, or the first year of life and future risk of allergic or autoimmune disease. We identified 260 original studies (964,143 participants) of milk feeding, including 1 intervention trial of breastfeeding promotion, and 173 original studies (542,672 participants) of other maternal or infant dietary exposures, including 80 trials of maternal (n = 26), infant (n = 32), or combined (n = 22) interventions. Risk of bias was high in 125 (48%) milk feeding studies and 44 (25%) studies of other dietary exposures. Evidence from 19 intervention trials suggests that oral supplementation with nonpathogenic micro-organisms (probiotics) during late pregnancy and lactation may reduce risk of eczema (Risk Ratio [RR] 0.78; 95% CI 0.68–0.90; I2 = 61%; Absolute Risk Reduction 44 cases per 1,000; 95% CI 20–64), and 6 trials suggest that fish oil supplementation during pregnancy and lactation may reduce risk of allergic sensitisation to egg (RR 0.69, 95% CI 0.53–0.90; I2 = 15%; Absolute Risk Reduction 31 cases per 1,000; 95% CI 10–47). GRADE certainty of these findings was moderate. We found weaker support for the hypotheses that breastfeeding promotion reduces risk of eczema during infancy (1 intervention trial), that longer exclusive breastfeeding is associated with reduced type 1 diabetes mellitus (28 observational studies), and that probiotics reduce risk of allergic sensitisation to cow’s milk (9 intervention trials), where GRADE certainty of findings was low. We did not find that other dietary exposures—including prebiotic supplements, maternal allergenic food avoidance, and vitamin, mineral, fruit, and vegetable intake—influence risk of allergic or autoimmune disease. For many dietary exposures, data were inconclusive or inconsistent, such that we were unable to exclude the possibility of important beneficial or harmful effects. In this comprehensive systematic review, we were not able to include more recent observational studies or verify data via direct contact with authors, and we did not evaluate measures of food diversity during infancy.ConclusionsOur findings support a relationship between maternal diet and risk of immune-mediated diseases in the child. Maternal probiotic and ...

Background Specific treatments for influenza are limited to neuraminidase inhibitors and adamantanes. Corticosteroids show evidence of benefit in sepsis and related conditions, most likely due to their anti-inflammatory and immunomodulatory properties. Although commonly prescribed for severe influenza, there is uncertainty over their potential benefits or harms. This is an update of a review first published in 2016. Objectives To systematically assess the e ectiveness and potential adverse e ects of corticosteroids as adjunctive therapy in the treatment of influenza, taking into account di erences in timing and doses of corticosteroids.

A key step in the systematic review process is the assessment of the methodological quality (or risk of bias) of the included studies. At JBI, we have developed several tools to assist with this evaluation. As evidence synthesis methods continue to evolve, it has been necessary to revise and reflect on JBI's current approach to critical appraisal and to plan a strategy for the future. In this first paper of a series focusing on risk of bias assessment, we introduce our vision for risk of bias assessment for JBI. In future papers in this series, the methodological approach taken for this revision process will be discussed, along with the revised tools and guidance for using these tools.